PB2114: TREATMENT RESULTS IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA FROM HIGH-RISK GROUP
Authors: K. Filonenko, I. Kriachok, A. Martynchyk, I. Titorenko, Y. Stepanishyna, O. Aleksyk, K. Ukianchenko, I. Pastushenko, Y. Kushchevyy, O. Novosad, O. Karnabeda, I. Diagil, V. Kozlov
Journal: HemaSphere (2022)

Background: The “real-life” treatment approaches in the “difficult cases” vary depending on еру financial support of health-care system and local preferences in different countries. Such a kind of case is the patient with high risk DLBCL, in whom the standard treatment still does not allow to achieve the results of highest efficiency. Aims: Aim of our study was to compare efficacy and toxicity of different treatment regimens in patients with DLBCL from high-risk group. Methods: Prospective cohort study was conducted in four Ukrainian centers in 2014-2017. Patients with newly diagnosed DLBCL and ≥ 3 risk factors according to International Prognostic Index were treated according to “investigators decision” with 6-8 cycles of CHOP-like (1st group), R-CHOP (2nd group) or R-DA-EPOCH regimens (3rd group). Hear we present the results from the updated analysis of the study. Results: Totally 140 patients were included into analysis, 68 males (48.6 %), 72 females (51.4 %), in the age 23-86 years old, median age 63 years (95 % CІ 60;65). Observation period was 1-82 months, median – 56 months. Patients treated with CHOP-like regimens were included into the 1st group (53 patients, 37.9%), treated with R-CHOP – into the 2nd group (60 patients, 42.9%) and 27 patients (19.2%) treated with R-DA-EPOCH – into the 3rd group. Significant difference between the groups was observed by the age (younger patients in the 3rd group, p=0.042) and stages distribution (early stages were more common in the 1st group, p=0.05). Overall response rate was 61.5% in the 1st group, 52.5% in the 2nd group and 83.3 % in the 3rd group (p=0.01). Complete response rate was 17.3%, 42.5% and 83.3%, respectively (p<0,001). 3-year event-free survival (EFS) was 41,3±7.3% in the 1st group, 49.9±7.2% in the 2nd group and 83,9±7.4% in the 3rd group (р=0,005). 3-year overall survival (OS) was 55.4±7.7%, 55.0±7.2% and 87.0±7.1%, respectively (р=0,008). The rates of hematological complications, thrombocytopenia and hepatotoxicity were comparable in three groups. Cardiotoxicity was less common in the group treated with R-DA-EPOCH (p<0,01). Neurotoxicity was more frequent in this group (p=0.043). Summary/Conclusion: The level of treatment response was significantly higher in the R-DA-EPOCH group. 3-year EFS was significantly higher in the R-DA-EPOCH group. Presented analysis also showed the significantly higher 3-year OS in the R-DA-EPOCH group, that was not shown in the final analysis performed in 2017. Toxicity was acceptable in all groups. We did not observe significant differences in the hematological toxicity, that may be explained by the features of local supportive care. The cardiotoxicity was less common and neurotoxicity was more frequent in the R-DA-EPOCH group. Despite the limitations of the study, we suggest the R-DA-EPOCH regimen could be considered as the most efficient treatment regimen in patients with DLBCL from high-risk group.